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    v1.0.28
    OpenPayerPolicy UpdatesPsychiatry/Behavioral HealthCA DHCS mobile crisis coverage update | OpenPayer
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    DraftCalifornia Department of Health Care ServicesPolicy N/A

    Community-Based Mobile Crisis Response Services

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    Establishes statewide (county-opt-in) authority and requirements for providing community-based mobile crisis response services to eligible Medi‑Cal beneficiaries experiencing a mental health or substance use disorder crisis; governs department authority, county participation, provider requirements, and funding rules.

    Policy Summary
    PayerCalifornia Department of Health Care Services
    PolicyCommunity-Based Mobile Crisis Response Services
    Policy CodePolicy N/A
    Change TypeStatutory addition / implementation conditions
    Effective DateApr 1, 2027
    Next Review DateN/A
    Key ActionCounties must opt in and certify qualifying local funds and provide the nonfederal share via intergovernmental transfers before services are available.
    SourceLink
    POLICY UPDATE CHANGES

    Establishes authority for the department to seek federal approval and implement community-based mobile crisis response services for eligible Medi‑Cal beneficiaries.

    Authorizes county opt-in for program participation and requires participating counties to provide the nonfederal share of costs via intergovernmental transfers.

    Limits implementation to periods when federal approvals and federal financial participation are available and specifies implementation timing and sunset/operative dates.

    Defines 'community-based mobile crisis response services' and references existing definition for 'Medi-Cal behavioral health delivery system.'

    Authorizes the department to enter into exempt contracts for implementation and training, with a specified inoperative date for that subdivision.

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    county opt-inParticipation model (county must agree to participate)
    nonfederal shareLocal funding requirement for participating counties
    2027-04-01Operative date of the statute
    exempt until 2031-06-30Procurement-exempt contracting authority in subdivision
    definition addedService definition added

    Coverage criteria for community-based mobile crisis response services

    inv-01: Conditional coverage for community-based mobile crisis response services

    Covered when ALL of the following are met:

    conditions_for_coverage: (1) The department has obtained necessary federal approvals and federal financial participation is available; (2) The county in which the beneficiary is located has opted in to provide community-based mobile crisis response services and has agreed to fund the nonfederal share of applicable expenditures through intergovernmental transfers and certified that those local funds qualify for federal financial participation; (3) Services are delivered to an eligible Medi‑Cal beneficiary experiencing a mental health or substance use disorder crisis exclusively through the Medi‑Cal behavioral health delivery system in a participating county; (4) Services are provided by authorized providers in accordance with department-established requirements and any utilization controls that the department issues once federal approval and guidance are obtained.

    All listed conditions must be satisfied for coverage to apply; county participation and federal approval are prerequisites.

    This section makes clear that counties are not required to provide community-based mobile crisis response services. Participation is voluntary: a county must opt in to offer the services. Counties that choose to participate must fund the required nonfederal share of costs through intergovernmental transfers and certify that those local funds qualify for federal financial participation. The statute also prohibits the use of General Fund moneys to satisfy the nonfederal share.

    Availability of community-based mobile crisis response services is gated on federal approval. The department must obtain all necessary federal approvals and federal financial participation must be available before services may be provided. Because the statute’s coverage depends on county opt-in and federal approval, the law does not enumerate clinical “not medically necessary” exclusions; instead, service availability is contingent on administrative and funding conditions established by the department and federal authorities.

    Provider requirements, county participation, and utilization controls

    Prior Authorization

    Follow department-established requirements and utilization controls

    The department will establish requirements for receipt of community-based mobile crisis response services and for authorized providers, which may include utilization controls; providers must follow those department-established requirements once federal approvals are obtained and guidance is issued.

    • Includes development of utilization controls and requirements for authorized providers.
    • Department will oversee and enforce the requirements and guidelines it develops.
    Note

    Monitor and comply with department guidance and communications

    The department may implement, interpret, or make specific this section, in whole or in part, by plan or county letters, information notices, plan or provider bulletins, or other similar instructions without further regulatory action; providers must monitor and comply with such guidance when issued.

    • Department will consult with stakeholders to the extent practicable when issuing guidance.

    Background and intent

    The statute’s intent is to establish a framework for delivering community-based mobile crisis response services—rapid response, individual assessment, and community-based stabilization—to Medi‑Cal beneficiaries experiencing a mental health or substance use disorder crisis. Implementation is limited to counties that agree to participate and to periods when the department has obtained the required federal approvals and federal financial participation is available. The department is charged with developing the operational requirements, certifying authorized providers, and overseeing compliance once federal approval is secured.

    Definitions

    inv-09: Community-based mobile crisis response services — rapid response, individual assessment, community-based stabilization
    DefinitionServices to provide rapid response, individual assessment, and community-based stabilization to Medi‑Cal beneficiaries who are experiencing a mental health or substance use disorder crisis.
    Service componentsRapid response, individual assessment, community-based stabilization (as stated in statute).
    ApplicabilityAvailable only when federal approvals and federal financial participation are obtained and available.
    Delivery settingProvided to Medi‑Cal beneficiaries in crisis; delivered through the Medi‑Cal behavioral health delivery system in participating counties per department guidance.
    Implementation guidanceDepartment may implement, interpret, or make specific the service definition and requirements via plan or county letters, information notices, plan or provider bulletins, or similar instructions.

    Level-of-care / service eligibility logic

    Permitted treatment modalities and service elements

    inv-12: Mobile crisis intervention / community stabilization

    modalities: Rapid response, individual assessment, and community-based stabilization interventions as defined in this section and by any applicable federal statute or department guidance for community-based mobile crisis response services.

    Exact clinical components and operational definitions will be provided following federal approval and by department guidance.

    Policy Summary
    PayerCalifornia Department of Health Care Services
    PolicyCommunity-Based Mobile Crisis Response Services
    Policy CodePolicy N/A
    Change TypeStatutory addition / implementation conditions
    Effective DateApr 1, 2027
    Next Review DateN/A
    Key ActionCounties must opt in and certify qualifying local funds and provide the nonfederal share via intergovernmental transfers before services are available.
    SourceLink
    On This Page
    Coverage criteria for community-based mobile crisis response servicesProvider requirements, county participation, and utilization controlsBackground and intentDefinitionsLevel-of-care / service eligibility logicPermitted treatment modalities and service elements
  1. Guidance may include plan or county letters, information notices, plan or provider bulletins, or similar instructions.
    2. Documentation Required

    Ensure county certifies nonfederal funds for federal participation

    Each participating county must certify that the local funds it uses to fund the nonfederal share of expenditures qualify for federal financial participation in the form and manner required by the department.

    • County certification is required for local funds used to fund the nonfederal share.
    • Nonfederal share must be funded via intergovernmental transfers in accordance with 42 C.F.R. §433.51.
    Denial Risk

    Do not provide mobile crisis services in counties that have not opted in

    Community-based mobile crisis response services are not available through a county’s Medi‑Cal behavioral health delivery system unless that county opts in and provides the required nonfederal share; providers in nonparticipating counties cannot be authorized to deliver these services.

    • This section does not require a county to provide services; participation is voluntary.
    • Services are available exclusively through Medi‑Cal behavioral health delivery systems in counties that agree to participate.
    inv-10: Medi‑Cal behavioral health delivery system — cross-reference to Section 14184.101 subdivision (i)
    Statutory reference'Medi‑Cal behavioral health delivery system' has the same meaning as set forth in subdivision (i) of Section 14184.101.
    Use in this sectionServices are available only when delivered through the Medi‑Cal behavioral health delivery system in participating counties and by authorized providers as defined by the department.
    Operational constraintAvailability is contingent on federal approvals and federal financial participation; department will issue guidance under this definition as needed.